Frankincense, Indian

Scientific Name(s): Boswellia serrata Roxb.
Common Name(s): Dhup, Indian frankincense tree, Indian olibanum, Salai guggal

Medically reviewed by Drugs.com. Last updated on Jun 21, 2021.

Clinical Overview

Use

The oleoresin gum from B. serrata has traditionally been used for its anti-inflammatory effects in conditions such as asthma, osteoarthritis, rheumatoid arthritis, colitis, and irritable bowel syndrome. It has also been used for the management of diabetes, urinary conditions, dermatological ailments, and renal impairment. Boswellic acids have demonstrated immunomodulatory, antiproliferative, cytotoxic, and antimicrobial effects; however, there are no adequate clinical trials to support any of the uses.

Dosing

Administration with high-fat foods may enhance plasma levels of B. serrata. Asthma: 300 to 400 mg of an extract (containing 60% boswellic acids) 3 times daily. In one trial, 300 mg 3 times daily of powdered gum resin capsules (S-Compound), or 400 mg 3 times daily of an extract (standardized to 37.5% boswellic acids per dose) was used. Inflammatory conditions: 300 to 400 mg of a B. serrata extract (containing 60% boswellic acids) 3 times daily was used in a clinical trial of patients with knee osteoarthritis. Two capsules of Articulin-F (contains B. serrata, Withania somnifera, Curcuma longa, zinc complex) 3 times daily; or supplementation with Casperome (150 mg of boswellic acids) 3 times daily has been used for inflammatory conditions such as osteoarthritis and rheumatoid arthritis. Ulcerative colitis: 350 to 400 mg 3 times daily.

Contraindications

Hypersensitivity to B. serrata.

Pregnancy/Lactation

Avoid use. Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

Substrates of cytochrome P450 (CYP-450) 1A2, 2C8, 2C9, 2C19, 2D6, and 3A4: Upon liquid chromatography mass spectrometry analysis, frankincense derived from B. serrata demonstrated inhibition of CYP1A2, 2C8, 2C9, 2C19, 2D6, and 3A4. Therefore, caution is warranted when using B. serrata with medications that are substrates for these isoenzymes. Substrates for P-glycoprotein (P-gp): Data suggest that B. serrata extract and the major boswellic acids may be potent inhibitors of P-gp via modulation of transport activity at the GI level, but not at the blood-brain barrier. Therefore, medications that depend on P-gp transport across the GI membrane may be impacted with coadministration of B. serrata. Warfarin: According to 2 case reports, coadministration of warfarin and B. serrata may increase international normalized ratio (INR) levels. The interaction may be attributed to inhibition of lipoxygenase and interference with COX-1 by B. serrata. In addition, B. serrata might inhibit CYP2C19, 3A4, and 2C9, which are involved in the metabolism of warfarin. Use of B. serrata in patients receiving warfarin is not recommended.

Adverse Reactions

Diarrhea, abdominal pain, and nausea have been reported.

Toxicology

No data.

Scientific Family

• Burseraceae

Botany

The Burseraceae family of trees and shrubs consists of 18 genera and more than 540 species that grow mostly in tropical regions of India (B. serrata), North Africa (Boswellia carteri, Boswellia frereana), and the Arabian Peninsula (Boswellia sacra). Most species contain resin ducts in the bark, which yield the products myrrh and frankincense.1, 2 B. serrata is a branching tree that grows on dry, hilly areas throughout most of India and can reach up to 3.7 m in height.3 When the bark is cut, the aromatic balsam, or gum re...